Association of adverse fetal outcomes with placental inflammation after oral gestational exposure to hexafluoropropylene oxide dimer acid (GenX) in Sprague-Dawley rats

Per- and polyfluoroalkyl substances (PFAS) and hypertensive disorders of Pregnancy- integration of epidemiological and mechanistic evidence

BACKGROUND

Hypertensive disorders of pregnancy (HDP) remain a significant global health burden despite medical advancements. HDP prevalence appears to be rising, leading to increased maternal and fetal complications, mortality, and substantial healthcare costs. The etiology of HDP are complex and multifaceted, influenced by factors like nutrition, obesity, stress, metabolic disorders, and genetics. Emerging evidence suggests environmental pollutants, particularly Per- and polyfluoroalkyl substances (PFAS), may contribute to HDP development.

OBJECTIVE

This review integrates epidemiological and mechanistic data to explore the intricate relationship between PFAS exposure and HDP.

EPIDEMIOLOGICAL EVIDENCE

Studies show varying degrees of association between PFAS exposure and HDP, with some demonstrating positive correlations, particularly with preeclampsia. Meta-analyses suggest potential fetal sex-specific differences in these associations.

MECHANISTIC INSIGHTS

Mechanistically, PFAS exposure appears to disrupt vascular hemodynamics, placental development, and critical processes like angiogenesis and sex steroid regulation. Experimental studies reveal alterations in the renin-angiotensin system, trophoblast invasion, oxidative stress, inflammation, and hormonal dysregulation - all of which contribute to HDP pathogenesis. Elucidating these mechanisms is crucial for developing preventive strategies.

THERAPEUTIC POTENTIAL

Targeted interventions such as AT2R agonists, caspase inhibitors, and modulation of specific microRNAs show promise in mitigating adverse outcomes associated with PFAS exposure during pregnancy.

KNOWLEDGE GAPS AND FUTURE DIRECTIONS

Further research is needed to comprehensively understand the full spectrum of PFAS-induced placental alterations and their long-term implications for maternal and fetal health. This knowledge will be instrumental in developing effective preventive and therapeutic strategies for HDP in a changing environmental landscape.

Reproductive toxicity of PFOA, PFOS and their substitutes: A review based on epidemiological and toxicological evidence

Per- and polyfluoroalkyl substances (PFAS) have already drawn a lot of attention for their accumulation and reproductive toxicity in organisms. Perfluorooctanoic acid (PFOA) and perfluorooctanoic sulfonate (PFOS), two representative PFAS, are toxic to humans and animals. Due to their widespread use in environmental media with multiple toxicities, PFOA and PFOS have been banned in numerous countries, and many substitutes have been produced to meet market requirements. Unfortunately, most alternatives to PFOA and PFOS have proven to be cumulative and highly toxic. Of the reported multiple organ toxicities, reproductive toxicity deserves special attention. It has been confirmed through epidemiological studies that PFOS and PFOA are not only associated with reduced testosterone levels in humans, but also with an association with damage to the integrity of the blood testicular barrier. In addition, for women, PFOA and PFOS are correlated with abnormal sex hormone levels, and increase the risk of infertility and abnormal menstrual cycle. Nevertheless, there is controversial evidence on the epidemiological relationship that exists between PFOA and PFOS as well as sperm quality and reproductive hormones, while the evidence from animal studies is relatively consistent. Based on the published papers, the potential toxicity mechanisms for PFOA, PFOS and their substitutes were reviewed. For males, PFOA and PFOS may produce reproductive toxicity in the following five ways: (1) Apoptosis and autophagy in spermatogenic cells; (2) Apoptosis and differentiation disorders of Leydig cells; (3) Oxidative stress in sperm and disturbance of Ca2+ channels in sperm membrane; (4) Degradation of delicate intercellular junctions between Sertoli cells; (5) Activation of brain nuclei and shift of hypothalamic metabolome. For females, PFOA and PFOS may produce reproductive toxicity in the following five ways: (1) Damage to oocytes through oxidative stress; (2) Inhibition of corpus luteum function; (3) Inhibition of steroid hormone synthesis; (4) Damage to follicles by affecting gap junction intercellular communication (GJIC); (5) Inhibition of placental function. Besides, PFAS substitutes show similar reproductive toxicity with PFOA and PFOS, and are even more toxic to the placenta. Finally, based on the existing knowledge, future developments and direction of efforts in this field are suggested.

Adverse effects of gestational exposure to hexafluoropropylene oxide trimer acid (HFPO-TA) homologs on maternal, fetal, and placental health in mice

In an effort to identify and develop potential alternatives for perfluorooctanoic acid (PFOA), PFDMO2HpA and PFDMO2OA have been engineered by reducing the -CF2 content in the molecular structure of hexafluoropropylene oxide trimer acid (HFPO-TA). Yet, despite their subsequent presence in environmental samples, there is a paucity of information regarding their toxicity, particularly on pregnancy. Here, pregnant CD-1 mice were exposed to PFDMO2HpA (0, 0.04, 0.16, 0.63, 2.5, or 10 mg/kg/day) or PFDMO2OA (0, 0.01, 0.04, 0.16, 0.63, or 2.5 mg/kg/day) via oral gavage from gestational days 2 (GD2) to 12 or 18 to evaluate the detrimental effects on dams and embryo-placenta units. Both two chemicals can transfer across the placenta, with a higher transfer ratio in late-pregnancy (GD18) than in mid-pregnancy (GD12), and PFDMO2OA being transferred at a higher rate than PFDMO2HpA. PFDMO2HpA/PFDMO2OA exposure caused maternal hepatotoxicity and fetal hepatomegaly, showing the lowest no-observed-adverse-effect level among all observed endpoints, which were used for calculating their reference dose (13.33 ng/kg/day). In the 2.5 and 10 mg/kg/day PFDMO2HpA groups as well as 2.5 mg/kg/day PFDMO2OA group at GD18, besides the abnormally high abortion rates exceeding 5 %, survival fetal weight was notably reduced (2.33 %, 6.44 %, and 5.59 % decrease relative to corresponding controls, respectively). Concurrently, placentas exhibited significant enlargement following PFDMO2HpA or PFDMO2OA exposure at doses of 0.63 mg/kg/day or higher, resulting in diminished placental efficiency. The deleterious effects of two chemicals on dams, fetuses, and placentas were stronger than that of PFOA or HFPO-DA, suggesting that neither PFDMO2HpA nor PFDMO2OA is suitable PFOA alternative. Bioinformatics analyses revealed significant alterations in the expression of genes involved in inflammation and immunity in the placenta upon exposure to 10 mg/kg/day PFDMO2HpA and 2.5 mg/kg/day PFDMO2OA at GD18, potentially elucidating mechanism behind the observed decrease in placental efficiency and increase in abortion rates after exposure.